Western Digital Technologies Health Insurance Association

Enrollees with Western Digital Technologies GK ,Western Digital Marketing GK

No.	Application Form	Document	Entry Sample	Submission
	Dependent Change Notification (Addition) Documents to attach when applying to add a dependent	PDF	Entry Sample	Agent in Charge of WDTJ Agent in Charge of WDMJ APO_Social Insurance Consultants Corporation Kagurazaka 1-chome Building 1-15 Kagurazaka, Shinjuku-ku, Tokyo, 162-0825 wdtj_shakaihoken@apol.jp wdmj_shakaihoken@apol.jp
	Dependent Certification Record	PDF	Entry Sample
	Dependent Certification Check List	PDF	Entry Sample
	Dependent Change Notification (Removal)	PDF	Entry Sample
	Application for Reissue of Insurance Card Elderly Recipient Certificate Eligibility Certificate for Ceiling-Amount	PDF	Entry Sample
	Address Change Notification of the Insured Person	PDF	Entry Sample
	Notification for Acquisition of Qualification as an Insured Person with Optional and Continued Insurance	PDF	Entry Sample	Western Digital Technologies Health Insurance Association Yoyogi East 5-23-5 Sendagaya, Shibuya-ku, Tokyo, 151-0051
	Application for Purchase of Exclusive Healthy Menu Option Coupons	PDF	Entry Sample

Insured Persons with Optional and Continued Insurance

No.	Application Form	Document	Entry Sample	Submission
	Dependent Change Notification (Optional and Continued Insurance)	PDF	Entry Sample	Western Digital Technologies Health Insurance Association Yoyogi East 5-23-5 Sendagaya, Shibuya-ku, Tokyo, 151-0051
	Application for Reissue of Insurance Card Elderly Recipient Certificate Eligibility Certificate for Ceiling-Amount Application (Optional and Continued Insurance)	PDF	Entry Sample
	Address Change Notification of the Insured Person (Optional and Continued Insurance)	PDF	Entry Sample
	Notification for Loss of Qualification as an Insured Person with Optional and Continued Insurance	PDF	Entry Sample

Standard Application Forms

*Insured persons with optional and continued insurance submit application forms to the Western Digital Technologies Health Insurance Association.

No.	Application Form	Document	Entry Sample	Submission
	Name Change Notification for Insured Person (Dependent)	PDF	Entry Sample	Agent in Charge of WDTJ Agent in Charge of WDMJ APO_Social Insurance Consultants Corporation Kagurazaka-1chome Building 1-15 Kagurazaka, Shinjuku-ku, Tokyo, 162-0825 wdtj_shakaihoken@apol.jp wdmj_shakaihoken@apol.jp
	Notification of Long-term Care Insurance Exemption	PDF	Entry Sample
	Notification of Long-term Care Insurance Exclusion	PDF	Entry Sample
	Application for Payment of Medical Care Costs (Paid in Advance/Therapeutic Devices, etc.)	PDF	Entry Sample	Western Digital Technologies Health Insurance Association Yoyogi East 5-23-5 Sendagaya, Shibuya-ku, Tokyo, 151-0051
	Receipt (Medical Examination) Statement	PDF	–
	Application for Payment of Medical Care Costs (Acupuncture/Moxibustion)	PDF	Entry Sample
	Application for Payment of Medical Care Costs (Massages)	PDF	Entry Sample
	Application for Health Insurance Payment of Funeral Fees (Expenses) for Insured Person or Family Member	PDF	Entry Sample	Agent in Charge of WDTJ Agent in Charge of WDMJ APO_Social Insurance Consultants Corporation Kagurazaka-1chome Building 1-15 Kagurazaka, Shinjuku-ku, Tokyo, 162-0825 wdtj_shakaihoken@apol.jp wdmj_shakaihoken@apol.jp
	Application for Lump-sum Balance of Childbirth/Childcare Allowance	PDF	Entry Sample
	Application for Payment of Childbirth/Childcare Lump-sum Allowance	PDF	Entry Sample
	Application for Payment of the Childbirth/Childcare Lump-sum Allowance (Substitute Payee System)	PDF	Entry Sample
	Application for Maternity Allowance	PDF	Entry Sample
	Application for Injury and Illness Allowance	PDF	Entry Sample
	Certificate of Consent	PDF	–
	Application for Issuance of Health Insurance Eligibility Certificate for Ceiling-Amount	Digital Application System		Western Digital Technologies Health Insurance Association Yoyogi East 5-23-5 Sendagaya, Shibuya-ku, Tokyo, 151-0051
		PDF	Entry Sample
	Health Insurance Application for Issuance of Certificate Issued for Specific Disease Treatment	PDF	Entry Sample
	Point Request for Influenza Vaccination Subsidy	Digital Application System
		PDF	Entry Sample
	Bank Account Change Notification for Payment Transfers	PDF	–
	Assistance Application for Medical Treatment to Quit Smoking	PDF	Entry Sample
	Application for Dental Examination Expense Assistance Payment Form	PDF	Entry Sample